World Health Organization: Syrian Arab Republic, Annual Report 2017

North-east Syria, much of which was under the control of the Islamic State of Iraq and the Levant (ISIL), was the focus of intense fighting in 2017. Health care services in all three north-eastern governorates1 were severely disrupted, leaving civilians caught up in the conflict more vulnerable than ever. Hundreds of thousands of people were displaced, many of them more than once, as they sought to escape shifting battle lines.

Following the start of the offensive to recapture Ar-Raqqa city from ISIL in June 2017, tens of thousands of civilians fled. Up to 15 000 civilians remained trapped in the city in increasingly desperate conditions. The city was retaken in October 2017, but it had been utterly devastated. Its main hospital had been destroyed in an airstrike, and all other hospitals had been forced to shut down due to military activity in the area. Thousands of civilians in the neighbouring governorate of Deir-ez-Zor were displaced following intensified military operations. In early September, government forces finally broke ISIL’s three-year siege on parts of Deir Ez-Zor city, but it too lay in ruins.

The acute insecurity caused by the fighting meant that most areas in north-east Syria were off-limits to humanitarian agencies. Nonetheless, a WHO team managed to travel to rural areas in Ar-Raqqa and Al-Hasakeh governorates in July to assess the situation at first hand. The team’s mission was to identify the hospitals and health care facilities to which patients could be referred, and explore ways of setting up triage mechanisms and evacuation routes for wounded patients. Alarmingly, it found that there was only one trauma stabilization point in the whole of Ar-Raqqa governorate. (Trauma stabilization points are essential because they give patients rapid access to life-saving first aid and advanced resuscitation techniques. Once stabilized, patients can then be transferred to other medical facilities for treatment.)

By the end of the year access to north-east Syria had improved but the situation remained extremely challenging due to the continuing shortage of functioning health care facilities and the overall insecurity. As 2017 drew to a close, over 80 000 internally displaced people (IDPs) were living in makeshift camps and spontaneous settlements in bitterly cold conditions, with access to only rudimentary heath care.

In the south of the country, 50 000 people, 80% of whom were women and children, remained trapped between Syria and Jordan following a decision by the Jordanian authorities to close the border. Humanitarian access to this area remains very limited, and reports indicate very high rates of diarrhoeal disease among children and increasing rates of common infections.